Abstract 2747: Lower Augmentation Index And Wave Reflection In Hypertensive Subjects Treated With Atorvastatin: An ASCOT-LLA Substudy
Background: HMG CoA reductase inhibitors (statins) lower serum cholesterol and reduce cardiovascular events in hypertensive subjects . Studies have reported that statins improve endothelial function, but their effects on brachial blood pressure (BP) are disputed. Recent studies suggest that central blood pressure and wave reflection may be better indicators of risk in hypertensive subjects. The Anglo-Scandinavian Cardiac Outcomes Trial included a lipid lowering arm (ASCOT-LLA) in which hypertensive subjects with total cholesterol <6.5mmol/L were randomized to atorvastatin 10mg (A) or placebo (Pl). We compared the effect of atorvastatin vs. placebo on central blood pressure and wave reflection in a substudy of ASCOT-LLA.
Methods: Carotid BP and flow velocity were measured by tonometry and Doppler ultrasound in 142 subjects (age =43–79 years; 127 male) who were randomized to Pl (n=63) or A (n =79). Augmentation index (AIx) was calculated and waveforms were separated into backward and forward components by wave intensity analysis. All data are means (SD).
Results: Brachial BP (Pl =132(14)/79(7)mmHg, A=131 (13)/79(7)mmHg; P 0.5 & 0.9 respectively) and carotid SBP (Pl = 129(13)mmHg, A = 128 (11) mmHg; p 0.6) were similar in both groups, but AIx was significantly lower in the statin-treated group (Pl = 27(10)%, A = 23(10)%; p = 0.03). Wave reflection from the body was lower in the statin-treated group (Pl =4.3(6.7)%, A = 2.5(3.6)%; p = 0.02) but reflection from the head did not differ significantly (Pl = 17.6(7.2) A = 18.0(7.7); p = 0.9). Carotid wavespeed and time of arrival of reflected wave did not differ between groups.
Conclusions: Statin treatment is associated with lower AIx and decreased wave reflection from the body. This could be due to an improvement in endothelial function and may contribute to the reduction in risk of cardiovascular events seen in ASCOT-LLA.